GI Flashcards
(89 cards)
1
Q
Leading cause of acute and chronic pancreatitis
A
Alcohol
2
Q
Two functions of pancreatitis
A
Endocrine-insulin
Exocrine-digestive enzymes
3
Q
Second cause of acute pancreatitis
A
Gallbladder disease
4
Q
S/S of pancreatitis
A
Pain Abdominal distention/ascites Abdominal mass-swollen pancreatitis Rigid board-like abdomen (guarding or bleeding) Bruising around umbilical area (Cullen's sign) Flank area bruising (Gray Turner's sign) Fever N/V Jaundice Hypotension=bleeding or ascites
5
Q
Pancreatitis
A
Auto-digestion of pancreatitis-it’s eating itself
6
Q
Does pain with pancreatitis increase or decrease with eating?
A
Increase
7
Q
Diagnostic labs for pancreatitis
A
Increased serum lipase and amylase Increased WBCs Increased BS ALT, AST-liver enzymes increased PT, PTT longer Serum bilirubin increased H/H increased or decreased (Down with bleeding, up with dehydrated)
8
Q
Normal amylase labs
A
30-220 U/L
9
Q
Normal lipase labs
A
0-110 U/L
10
Q
Normal AST labs
A
8-40 U/L
11
Q
Normal ALT labs
A
10-30 U/L
12
Q
Tx of pancreatitis
A
Control pain (Decrease gastric secretions: NPO to suction, bed rest. If anything gets in their stomach, they think they have to make digestive enzymes, increasing pain.)
Steroids to decrease inflammation
Anticholinergics to keep stomach dry and empty (Benztropine, atropine/diphenoxylate)
GI protectants (pantoprazole, ranitidine, famotidine, antacids)
Maintain nutrition status then ease into diet
Insulin-sick pancreas, not making insulin, on steroids which increase BS, on TPN
13
Q
If you stay on steroids too long what could you get?
A
Cushing’s
14
Q
4 major functions of liver
A
- Detoxify body
- Helps blood clot
- Metabolize drugs
- Synthesized albumin
15
Q
If liver is sick, do what with meds?
A
Decrease dose
16
Q
If liver is sick, #1 concern is what?
A
Bleeding
17
Q
Antidote for acetaminophen
A
Acetylcysteine
18
Q
Cirrhosis patho
A
Liver cells are destroyed and replaced with connective/scar tissue which alters the circulation within the liver, the BP in the liver goes up, called portal HTN
19
Q
S/S of cirrhosis
A
Firm, nodular liver Abdominal pain-liver capsule stretched Chronic dyspepsis Change in bowel habits Ascites Splenomegaly Decreased serum albumin Increased ALT and AST Anemia Can progress to hepatic encephalopathy/coma
20
Q
Are you suppose to be able to feel the liver normally?
A
No
21
Q
Never give what to someone with liver problems?
A
Acetaminophen
22
Q
Male hemoglobin
A
14-18
23
Q
Female hemoglobin
A
12-16
24
Q
Male hematocrit
A
42-52%
25
Female hematocrit
37-47%
26
Cirrhosis Dx
Ultrasound
CT, MRI
Liver biopsy
27
Liver biopsy procedure
Clotting studies pre procedure: PT, aPTT, INR
Vitals pre procedure
Position supine with right arm over head
Exhale and hold breath to keep diaphragm out of the way
Lie on right side post procedure, worried about bleeding so take vitals
28
Tx of cirrhosis
Antacids, vitamins, diuretics
No more alcohol
I&O, daily weights
Rest
Prevent bleeding, no IM injections or aspirin
Measure abdominal girth to see if ascites is increased
Paracentesis
Monitor jaundice-good skin care, short nails
Avoid narcotics-liver can't metabolize drugs well when it's sick
Decrease protein, low Na diet
29
Paracentesis
Removal of fluid form the peritoneal cavity
Have client void
Position sitting up
Vitals
With "shocky" clients, the BP goes down and pulse goes up
30
Why worry about shock with paracentesis?
Any time you pull fluids, you can throw them into shock
31
Protein breaks down to what?
Ammonia, then the liver converts ammonia to urea, then the kidneys excrete the urea
32
Patho of hepatic coma
When you eat protein, it transforms into ammonia, and the liver converts it to urea. Urea can be excreted through the kidneys without difficulty
When the liver becomes impaired, it can't make this conversion, so ammonia builds up in the blood
Serum ammonia decreases LOC (acts like sedative)
33
S/S of hepatic coma
```
Minor mental changes/motor problems
Difficult to awaken
Asterixix-flaping tremor of hand
Handwriting changes
Reflexes will decrease
EEG slow
Fetor-breath smells like ammonia (acetone, cut grass)
Anything that increases ammonia level aggravates the problem-protein
Liver people tend to be GI bleeders
```
34
Tx of hepatic coma
Lactulose to decrease serum ammonia
Cleansing enemas
Decrease ammonia in diet
Monitor serum ammonia
35
Patho of bleeding esophageal varices
High BP in the liver (portal HTN) forces collateral circulation to form in stomach, esophagus, rectum
Usually no problem until rupture
Protruding vessel, same thing as a hemorrhoid
36
When you see an alcoholic client that is GI bleeding it is usually what?
Esophageal varices
37
Tx of esophageal varices
```
Replace blood
VS, CVP
Oxygen (needed whenever someone is bleeding)
Octreotide to lower BP in liver
Balloon tamponade
Cleansing enema to get rid of old blood
Lactulose to decrease ammonia
Saline lavage to get blood out of stomach
```
38
Type of balloon tamponade tube
Sengstaken-Blakemore
39
Balloon tamponade
Infrequently used emergency procedure that may be used to stabilize clients with severe hemorrhage. Should not be used more than 12 hours. Many of the safety implications for the Blackemore tube can be applied to other oropharynx or nasopharynx tubes
40
Purpose of balloon tamponade
To hold pressure on bleeding varices
41
EVL or Endoscopic Sclerotherapy
More commonly used for esophageal varices. Uses a banding procedure and endoscopic sclerotherapy is when the physician injects a sclerosing agent into the varices via an endoscope
42
Patho of peptic ulcers
Common cause of GI bleeds
Can be in esophagus, stomach or duodenum
Mainly in males, but increasing in females
Erosion is present
43
S/S of peptic ulcers
Burning pain usually in the mid-epigastric area/back
Heartburn
Might point to a "hunger" region after they already ate
44
Diagnosis of peptic ulcers
Gastroscopy (EGD, endoscopy)
- NPO pre procedure
- Sedated
- NPO until gag reflex
- Watch for perforation by watching for pain, bleeding, or if they are having trouble swallowing
OR
Upper GI:
-Looks at the esophagus and stomach with dye
NPO past midnight
No smoking, chewing gum, or mints. Remove nicotine patch. Smoking increases stomach motility, which will affect the test. Smoking also increases stomach secretions which will increase the chance of aspiration
45
Tx of peptic ulcers
Antacids
Proton pump inhibitors
H2 antagonist
46
What do you do if balloon tamponade is stuck in clients throat and they can't breathe?
Deflate the balloon by keeping scissors at HOB and chop it in half for immediate deflation, reestablish airway
47
Why antacids for peptic ulcers?
Liquids, coat stomach
Take when stomach is empty and at bedtime.
Acid can get on ulcer, take antacid to protect ulcer
48
Why proton pump inhibitors for peptic ulcers?
To decrease acid secretions
| Omeprazole, lansoprazole, pantoprazole, esomeprazole
49
Why H2 antagonists for peptic ulcers?
Ranitidine, famotidine
GI cocktail (donnatal, siscous lidocaine, mylanta)
Antibiotics for H. Pylori
Sucralfate to form barrier over the wound so acid can't get on the ulcer
50
Client teaching for peptic ulcers
Decrease stress
Stop smoking
Eat what you can tolerate, avoid temp extremes and extra spicy foods, avoid caffeine
Need to be followed for one year
51
Gastric ulcers
Malnourished (bc throwing up helps): pain is usually half hour to one hour after meals, food doesn't help, vomiting helps, vomit blood
52
Duodenal ulcers
Well nourished: night time pain is common and 2-3 hours after meals, food helps, blood in stools
53
Hiatal hernia patho
When the hole in the diaphragm is too large so the stomach moves up into the thoracic cavity
Main cause is a large abdomen
Other causes are congenital abnormalities, trauma, sx
54
S/S of hiatal hernia
Heartburn
Fullness after eating
Regurgitation
Dysphagia
55
Tx of hiatal hernia
Small frequent meals, sit up 1 hour after eating, elevate HOB, sx, teach life style changes and healthy diet (keep stomach in down position)
56
Dumping syndrome
The stomach empties too quickly after eating and the client experiences many uncomfortable to sever side effects. Usually secondary to gastric bypass, gastrectomy, or gall bladder disease
57
S/S of dumping syndrome
```
Fullness
Weakness
Palpitations
Cramping
Faintness
Diarrhea
```
58
Tx of dumping syndrome
Semi recumbent with meals
Lie down after meals
No fluids with meals (drink in between meals)
Meals should be small and frequent rather than large
Avoid foods high in carbs and electrolytes, carbs and electrolytes empty fast
59
Ulcerative colitis patho
Ulcerative inflammatory bowel disease, just in large intestine
60
Crohn's Dz
Also called regional enteritis, inflammation and erosion of the ileum but it can be found anywhere in the small or large intestines
61
S/S of ulcerative colitis and crohn's disease
```
Diarrhea
Rectal bleeding
Weight loss
Vomiting
Cramping
Dehydration
Blood in stools
Anemia
Rebound tenderness
Fever
```
62
Rebound tenderness
Push in, let go and hit hurts
| Means peritoneal inflammation
63
Diagnosis of ulcerative colitis and crohn's disease
CT
Colonoscopy-best
Barium enema-Lower GI series, done if colonoscopy is incomplete
64
Colonoscopy procedure
Clear liquid diet for 12-24 hours
NPO 6-8 hours pre procedure
Avoid NSAIDs to avoid GI bleeding
Laxatives or enemas until clear
Polyethylene glycol-don't drink with straw, will swallow air
To help your client drink colon prep more easily, get it as cold as possible
Sedated for procedure
Post op: watch for perforation. We are going to assume the worst, signs of perf are pain or unusual discomfort
65
Tx of ulcerative colitis and crohn's
Low fiber diet, try to limit GI motility to help save fluid
| Avoid cold foods, hot foods, smoking-these all increase motility
66
Medications for ulcerative colitis and crohn's
Antidiarrheals-only given with mildly symptomatic UC clients, doesn't work well in severe cases
ABX
Steroids to decrease inflammation
67
Sx for UC
Total colectomy with ileostomy formed
| Koch's ileostomy or a J pouch (no external bag)
68
Koch Pouch
qNipple valve that opens and closes to empty intestines
69
J pouch
Removes the colon and attaches the ileum to the rectum
70
Sx for crohn's
Try not to do sx
May remove only affected area
Client may end up with an ileostomy or colostomy, depends on area affected
An ostomy in the ileum is called an ileostomy and an osmotic in the colon is called a colostomy
71
Post op ileostomy care
It's going to drain liquid all the time. Don't have to irrigate ileostomies
Avoid foods hard to digest and rough foods: increase motility
Gatorade or a similarly electrolyte replacement drunk in summer
At risk for kidney stones (always a little dehydrated
72
Post op colostomy care
As waste moves through the colon, water and nutrients are being absorbed and the stool is forming
Irrigate for regularity. Same time every day, after a meal
The further down the colon the stoma is, the more formed the stool will be because water is being drawn out. The stool is more normal
When you're irrigating an osmotic, use same principles as if you're administering an enema
73
Any time you're giving an enema, what do you do if the client starts to cramp?
Stop fluids, lower bag and/or check the temp of the fluid
74
Stools with ascending and transverse colostomy
Semi liquid
75
Stools with descending or sigmoid colostomy
Semi formed for formed
76
Which colostomies do you irrigate?
Descending and sigmoid
77
Positioning of colons
Ascending, transverse, descending, sigmoid, rectum
78
Patho of appendicitis
Related to a low fiber diet, number one thing to worry about it rupture
79
S/S of appendicitis
Generalized pain initially: eventually localizes in the right lower quadrant (McBurney's Point)
Rebound tenderness
N/V
Get good hx ( abdominal pain first then N/V)
Anorexia
80
Which side do they lay on for enemas
Left, normal flow of GI tract
| If irrigating a stoma, they don't have to be on their side bc they don't have a rectum, any position is okay
81
Diagnosis of appendicitis
Increased WBC
Ultrasound
CT
Do not give enemas or laxatives because you are worried about ruptured appendix
82
Tx of appendicitis
Sx
Most done via laparoscope unless perforated
After any major abdominal sx, the position of choice is sitting up, no tension on suture
83
Why put client on right side with HOB elevated after ensure?
Stomach will empty quicker, if they vomit they won't aspirate, it will come out
84
TPN considerations
```
Sometimes called hyperalimentation
Keep refrigerated, warm for administration, let sit out for a few minutes prior to hanging
Central line needed
Filter needed
Nothing else should go through this line (dedicated line)
D/C gradually to avoid hypoglycemia
Daily weights
May have to start taking insulin
BG monitoring q 6
Check urine for glucose and ketones
Do not mix ahead: mixture changes every day according to electrolytes
Can only be hung for 24 hours
Change tubing with each new bag
IV bag may be covered with dark bag to prevent chemical breakdown
Needs to be on a pump
Home TPN: emphasize hand washing
Most frequent complication: infection
```
85
If appendix ruptures, what do you do?
Straight to sx, they'll be leaking bowel contents into abdomen, they'll get septic
Put on right side and sitting up so all bowel contents will settle in one spot
86
Assisting physician with inserting a central line
Have saline available for flush, don't start fluids until positive confirmation of placement with CXR
Trendelenburg to distend veins
87
If air gets in central line, what position do you put the client in?
Left side trendelenburg
| *When an air embolus is suspected in the heart, the client may be taken to the cath lab for removal of the air
88
Han you are changing the central line tubing, how can you avoid getting air in the line?
Clamp it off, valsalva, take a deep breath and HUMMMM
89
Why is an x-ray done on post insertion of central line
To check for placement and make sure they don't have a pneumothorax
